We carried out an announced comprehensive inspection on 18 January 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Evans Orthodontic Practice - Hereford provides NHS orthodontic treatment for children and young people in Herefordshire and surrounding counties. The practice is situated in the centre of Hereford in a listed period property and is operated by a partnership. One of the two partners is also the registered manager with CQC. A registered manager is a person who is registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The clinical team consists of two orthodontists, a part time orthodontic therapist, three dental nurses and a trainee dental nurse. The clinical team is supported by a practice manager and two receptionists. The practice also employs a maintenance person.

The practice has one communal treatment room with individual treatment areas divided by glass partitions. There is a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The reception area, treatment room and waiting room are all on the ground floor. There is level access into the building from outside.

The practice is open for appointments from 8.30am to 5pm Monday to Wednesday and 8am to 4pm on Thursdays and Fridays. The practice does not provide appointments between 1pm and 1.30pm but remains open throughout the day so patients can call in or telephone.

Before the inspection we sent CQC comment cards to the practice for patients to tell us about their experience of the practice. We collected 45 completed cards all but four of which were complimentary about the care and treatment the practice provides. Information from the practice’s own patient surveys over several years and from their NHS Friends and Family results was also generally very positive.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was their experience. National guidance for cleaning, sterilising and storing dental instruments was generally followed although some aspects of this needed to be reviewed.

• The practice had systems, medicines and equipment for the management of medical emergencies and staff were trained to know how to deal with these. Some equipment checks needed to be done more frequently.

• The practice had safeguarding processes and staff understood their responsibilities for safeguarding children and adults.

• Staff received training appropriate to their roles and were supported to meet the General Dental Council’s continuous professional development requirements.

• The practice had received no complaints but had a system for handling and responding to these.

• The practice used in-house surveys and the NHS Friends and Family Test to enable patients to give their views about the practice. They had established a patient liaison group to help them increase and maintain standards and discuss concerns and improvements.

• The practice had policies, procedures and risk assessments to help them manage the service.

• Recruitment procedures did not include specific details about the required information for staff employed.

• The practice used audits to monitor the quality of various aspects of the service.

We found areas where the provider could make improvements and should:

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and from other relevant bodies such as Public Health England (PHE).

• Review the practice's recruitment arrangements so these fully reflect relevant legislation and guidance and set out the information required in respect of persons employed by the practice.

• Review the availability of manufacturer’s data sheets with reference to the Control of Substance Hazardous to Health (COSHH) Regulations 2002.

• Review the practice’s infection control procedures giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance. This should include confirming suitable products with equipment manufacturers, reviewing the use of a bur brush for cleaning instruments and increasing the frequency of some checks.

• Review the arrangements for regular routine fire safety checks and tests.

• Review the security of prescription pads in the practice and the systems to monitor and track their use giving due regard to guidance from NHS Protect.

• Review reception staffing arrangements taking into account the impact on the practice manager’s ability to complete all aspects of their management role.

The practice was very busy but staff worked hard to keep delays to a minimum. People we spoke with were positive about the treatment provided. People's treatment was planned and discussed with them and based on their assessed needs. One parent whose children had recently had their braces removed said they were all, “really pleased” with the results. Another person told us they were pleased with the way their children had things explained to them.

There was equipment available for medical emergencies and staff were trained to know what to do if a person became unwell at the practice. Arrangements for the emergency medicines kept at the practice needed to be improved.

The practice was clean when we visited and people we spoke to confirmed that this was their experience too. We saw that there were suitable arrangements for the cleaning, sterilising and storing of instruments. A dental nurse explained these procedures to us clearly.

We saw evidence that health and safety related risks were identified and assessed. Regular audits were done to check that patient records contained the necessary information. A start had been made on consulting people about the service in a structured way. The provider was disappointed they had not made more progress with this.